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Mental Illnesses: What Do You Do When the Medication Ends?

Dr. Samson Tse works on recovery methods for mental illness patients in Hong Kong.

It’s a normal Wednesday morning and Sai Ying Pun is full of people getting on with their daily lives. A security guard is greeting a resident of Siu On Building when a piercing scream breaks out. His head snaps back to find the source of the sudden noise—and when he spots it, the hairs on his neck rises in a cold chill. Just a street across, pedestrians are running in every direction from a man brandishing two meat cleavers at a middle-aged woman. The guard’s legs freeze and he watches, horrified, as the woman escapes and the attacker turns to a man close by to be his next victim.

In late 2015, a discharged psychiatric patient slashed two random passers-by on Des Voeux Road West. And this was not an isolated case—the last year alone has seen the news reporting at least ten cases of random attacks on the streets by past or present sufferers of mental illnesses. Whether or not the attackers really have a mental illness background, two things are for certain: these incidents do not help to reduce the stigma of those who are recovered, nor do they increase the population’s confidence in the government’s commitment to mental health care.

“Recovery means an individual feels good, finds new directions and experiences joy in becoming a contributing member of a society or neighbourhood,” said Dr. Samson Tse, a professor and researcher at University of Hong Kong’s Faculty of Social Science. “The current method adopted by hospitals in Hong Kong is to prescribe medication to a patient then expect them to rejoin society once their symptoms have disappeared. But recovery isn’t as simple as healing a broken bone. It’s an ongoing, perhaps never-ending, journey.”

The professor rifled through the neat stack of papers on his otherwise spotless desk, searching for relevant data to back up his point. He is a small man with a pair of black-rimmed glasses, dressed in a white shirt with a pen tucked tidily in to the pocket. His office room echoes pristine order, with the books on the shelf organised neatly. A small photo of his family perched at the corner of his computer screen is the only personal touch.

Dr. Tse has been working with mental illness patients for years—whether it’s face-to-face in a high-security forensic psychiatric unit in New Zealand or from afar, examining the complex mechanisms of recovery from long-term diseases such as bipolar disorder and schizophrenia. Having spent the majority of his education and career abroad, he returned to Hong Kong in 2009 to introduce the new, consumer-based concept of recovery, known as “personal recovery”.

In other parts of the world, recovery doesn’t end when doctor visits cease. Recovery doesn’t end when physical symptoms have disappeared. Recovery doesn’t end when a person starts working again. The reason that relapse is so common in mental disorder recovery is because it extends beyond the physicality of the body—precisely what Dr. Tse explores: what do you do when the medication ends?

Unlike Western countries, Asia’s population has a more rigid view on mental illness. In Hong Kong, those with mental disorders are seen as crazy people. The topic is practically taboo and hardly voiced aloud in public. Family members of past and present sufferers do not talk of it even with their extended families as it brings shame to them. Despite worldwide growing acceptance to non-physical sicknesses, the city has not seen a quick-enough progress of the inhabitants’ understanding in this area of study.

The main differences between the Western and local concept of mental illness recovery is that Hong Kongers place strong emphasis on controlling or eliminating symptoms and reclaiming life roles in work. Recovery is viewed as an outcome, a box to be checked off on a to-do list, as opposed to the view overseas, where it is seen as a process. In his works, Dr. Tse exemplifies the two outlooks with the Asian question, “have I recovered?” versus the Western question, “what is my recovery journey?”.

But changing the perception of recovery is precisely where Hong Kong runs into a problem. It isn’t easy for these people to find jobs and get their lives back on track as discrimination remains in all areas—in the workplace and even at home. Ask the typical Hong Konger whether they would feel safe if a past mental disorder sufferer was living next door to them, and the majority would reply “no”.

In Hong Kong, the mental health service landscape is a far cry from New Zealand’s, where Dr. Tse spent half of his life. The percentage of the local government’s GDP invested into mental healthcare is only 0.2% as opposed to New Zealand’s 0.9%. In fact, there is no direct translation of the word ‘recovery’ in Chinese. It is no wonder Chinese communities are so lost when it comes to mental illnesses.

Dr. Tse brings what he learned throughout his twenty-five years in New Zealand to Hong Kong in order to benefit recovered patients, current patients and the public. Going beyond medication, he and his team are constantly working on providing meaningful life roles to the recovered. They have found constant and incredible results in their peer support service programs.

“With funding, we have trained three cohorts of peer support workers in the past few years,” explained the professor. “These workers are recovered patients. They have turned their mental illnesses into their strengths, for example through sharing their personal stories with current sufferers. As we talk, forty people are employed by NGOs to run groups!”

A smile broke through Dr. Tse’s face as he recalled the memory.

“There isn’t a singular most emotionally rewarding situation, but there is a stand-out memory I remember very clearly,” he said. “Nowadays, my team even hires recovered sufferers to help with research. A few years ago, there was one particular data set that didn’t make sense to me, no matter how many times I went back to it. In the end, I scheduled a lunch meeting with two recovered patients—one man and one woman.”

The data that Dr. Tse found incomprehensible was about factors that were involved with the stability of bipolar disorder recovery. Contrary to expectations, one of the listed factors that facilitated the process was excessive drinking.

“Binge-drinking is something that we think is bad, right? But it was such an exciting breakthrough to find out why from first-hand experience. During the meeting, the man and woman said to me, “Samson, can’t you see it? Drinking is associated with socialisation and many users may have used it to keep their friendships as the disease worsens!”.”

Suddenly, Dr. Tse saw the whole picture. Even everyday individuals would use alcohol as an aid in socialisation. What’s more, drinking excessively may mean forgetting—the mental illness sufferers can numb their problems that they do not want to deal with.

It’s obvious that personal recovery, or recovery through input from users as the professor calls it, is greatly beneficial for the mental illness community. But why is Hong Kong still lagging behind in terms of adopting this practice that many countries have today?

“The lack of locally based professionals in the field only continues to fuel the discrimination and poor healthcare system in Hong Kong,” answered Dr. Tse. “It isn’t poor pay, though there are indeed fewer opportunities for those working in the mental health career path here, like practicing psychologists, nurses and counsellors. Not only is there not enough education in the area of psychology, it’s also just not everyone’s cup of tea. It’s emotionally heavy for the everyday Hong Konger who already suffers from constant stress, but it’s emotionally gratifying, too, if you can manage it.”

And gratifying is exactly how Dr. Tse feels when he helps a mental illness patient. Having attended church regularly since childhood, he grew up watching his peers express their struggles with identity, relationships and studies. It was a no-brainer when it came to choosing what career path to walk down when it came to his tertiary schooling. Even before graduation, Dr. Tse knew he wanted to work with people in a dynamic and interesting way.

“It was definitely mental health rather than physical habitation for me,” he said. “I wanted to deal with human issues and work with a variety of problems using multiple methods. For example, in orthopaedics, you ‘fix’ a range of movements—it’s all physical. Dealing with mental illnesses is different. It includes a lot of things, like seeing clients, integrating them back into society and organising events with the rest of the community for them.”

After obtaining a diploma in Occupational Therapy in the Hong Kong Polytechnic University, bright-minded Dr. Tse was asked by his favourite professor to work with her in her native country New Zealand. With scarce postgraduate opportunities in the early 1980s in Hong Kong, Dr. Tse flew to Auckland for what he had not known, at the time, would be the next two and a half decades of his life.

He continued after a brief pause as another memory sprang to his mind.

“I actually remember the exact scenario,” he said. “The interviewer flew to Auckland to meet me, and we sat on a patch of grass outside the hospital for the interview. I was offered a full time job at a forensic psychiatric unit on the spot.”

At the time, mental health service overseas was growing exponentially. It was right after the government-prompted 1988 Mason Report, a series of inquiries headed by Judge Ken Mason following multiple high-profile attacks and suicides involving mentally ill people. In New Zealand, state money was invested for seven new psychiatric units to be built. They were facilities catering to the mentally unwell involved with prison. As an occupational therapist, Dr. Tse had to work in a high-security institution with only twelve to fifteen people of expertise.

It was common for people to ask Dr. Tse if he was scared.

“I always told them I felt the exact opposite of fear. I felt safer, actually. There were premeasures taken and when it comes down to it, safety was not about physical establishments but close relationships.”

He explained further.

“If there are good relationships in place, then it’s all clear. As long as one of the staff has trust with the one of residents and vice versa, then if anything goes wrong, the pair can effectively communicate. At the end of the day, safety doesn’t come from alarms, electric fences or macho male nurses. It comes with communication.”

It was only logical that Dr. Tse’s timeline continued down the same path, given how inspired he felt from dealing with mental illness patients first-hand using the personal experience recovery method.

While working at the unit for three and a half years, he completed a masters in psychology part time and—smiling as he proudly presented his accomplishments—graduated with full marks and a distinction from Massey University. After a few years working as a lecturer, he once again graduated—this time with a doctoral degree from the University of Otago. His thesis was focused on recovery for bipolar disorder patients, which set the paving stone for his later works.

Dr. Tse’s return to Hong Kong in 2009 was due to an unexpected turn of events. He had settled in New Zealand well: he was married to a woman he loved with a son and earning a stable income working in an area he was passionate in. But when he received a call from his hometown with news that his mother was diagnosed with dementia, he knew he had to come back.

“It wasn’t my kind of lifestyle to ignore the problem and leave it all to my brothers and sisters. I did not want to abandon my family to live a life of bliss. I made the choice to come back.”

Although the poor mental healthcare landscape in Hong Kong meant that he had had to start from scratch in his career, the professor knew he had made the right decision. It was even more emotionally rewarding for him to bring changes to the people so close to him. In fact, it had to be him: no one else based locally had his experience and expertise from overseas.

Recovery through input from sufferers allows the public to enter their world. They need to be understood instead of having someone pathologise what they feel. Dr. Tse has brought a pioneering practice to Hong Kong by involving patients as partners in research, proving that the understanding of the disease is essential and beneficial for recovery in the local context.

With the peer support project strongly grounded as long as there is sufficient funding, Dr. Tse explains the next step in his work to continue to communicate to the public.

“It’s not published yet,” he said excitedly. “But it’s almost done. It’s about the concept of what I call ‘Toxic Space’. My team has done extensive research on the consequences of our typical fast-paced, urban lifestyle in Hong Kong—and the findings may surprise you. But apart from this, I still constantly work with patients face-to-face. There’s something different about it that separates it from research in the lab. There is nothing more gratifying than seeing them regain life.”

Image source: HKU Centre for the Enhancement of Teaching and Learning – CETL

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Social Fabric, Mill6 Foundation’s Spring 2016 Exhibition

Social Fabric is Mill6's Spring 2016 exhibition at The Annex.

A traditional art exhibition features one artist’s work from a single series. But today, exhibitions are no longer confined to one solo artist. They can range from a curator grouping several works influenced by a certain major event together, like the M+ Sigg Collection at Artistree, to including multiple works made of the same media in one space, like Statement 3: New Sculpture from Germany at the Goethe-Institut Hong Kong.

But in Central, a newer, rather rare type of exhibition has opened its doors to the public this April: Mill6 Foundation’s spring show, Social Fabric, held at event space The Annex.

Social Fabric’s full title is Social Fabric: New Work by Mariana Hahn and Kwan Sheung Chi, a duo showing of Berlin-born Mariana Hahn and Hong Kong-born Kwan Sheung-chi’s works, tied together by internationally renowned curator David Elliott.

As exhibitions have evolved over the years, so has the definition of art itself in the eyes of many in the art world. An exhibit like Social Fabric may well prompt some viewers to ask the bigger question of “what is art?” or whether it’s necessary to have interlocutors to help the public interpret art.

Hahn, who graduated from the University of Arts London, was taken with silk, a delicate material from China that is prominent in Hong Kong. Upon her arrival to the city, she stayed on Lantau Island and studied the “shu nu” — women who resided there and wove for a living. Her artistic practice has always been based on the notion that the act of “weaving” is a metaphor for the human anatomy. Using fabrics as her creative medium, her art works are essentially clothing items that can be viewed as the carrier of the living narrative. Her series of works in Social Fabric specifically explores the role of silk and how it has transformed Hong Kong over time.

In contrast, Kwan is based in the city. With a BA in Fine Arts from the Chinese University of Hong Kong, he is perhaps most known for founding various advocacy groups, such as Woofer Ten, which focuses on expressing local political and social issues using experimental art. His unusual works document his own life as a typical resident of the city, and the installations on display in Social Fabric demonstrate his role as an insider. They scrutinise the troubling question that a large percentage of youth in Hong Kong have about their hometown today — should they stay or leave, given the city’s past, present and anticipated future?

It’s not the first time multiple artists have collaborated for an exhibition. Yet previously, when a pair of artists who both had equal prominence worked on single show, they would produce works together, in that each artist would have physically altered the displayed work, or at least have had a say in the ideas behind the work during the creative process. There would be communication between the artists; a chemistry, a dialogue. But in Social Fabric’s case, what could possibly be the connection between the two series of works by these two very different artists?

When asked this question, Mill6 Foundation director Angelika Li had an answer that sounded like it had been rehearsed many times.

“I brought together these artists from very different backgrounds because I saw a similar sensibility in how they approach their work, despite their differing personalities,” she said. “Mariana has a very quiet, poetic way of talking about violent matters, and Chi is a very quiet person, yet his works speak very loudly.”

But a “similar sensibility” spoken from the mouth of a director of a charity organisation just isn’t enough. Hahn is Mill6’s inaugural artist-in-residence, and it feels as if the staff simply paired her with a local artist for convenience. Li, without status in the art world, would not convince many. This is where David Elliott comes in. With a worldwide reputation, the British curator has had 20 years of experience in the art field since beginning this journey as the director of the Museum of Modern Art in Stockholm until 2001. He has made himself a household name in the art world as a curator, adviser, writer and chairman. Invited by Li to curate Social Fabric, he has said he was “delighted” to be involved in such an exhibition — and who could doubt someone with such eminence?

Elliott definitely has a way with words. During the public sharing session of the exhibition, he pushed Li’s idea behind Social Fabric — the goal of which was to encourage viewers to see Hong Kong’s evolution through a different prism by contrasting past with present in unusual art forms.

“Mariana and Chi are two very different artists, but that’s how it works,” said Elliott at the public sharing session. “Although they had only met for the first time not long before the exhibition, instinctively, Mariana felt there was a way to work together. My role, as the curator, was to advise them on what to include.”

He explained the full picture.

“The name Social Fabric describes the collaboration perfectly well. It’s a joining of two cities, Hong Kong and Berlin, in a metaphor for the way Hong Kong migrants are woven together, just like Mariana’s weaving work. The different ideas and attitudes towards the city’s past, present and future — from Chi, as an insider looking out and from Mariana, as an outsider looking in — are woven together.”

The elaborate explanation nearly sounds convincing, coming from Elliott. But closer scrutiny of the information available about the artists themselves suggest otherwise. And it certainly did not seem to help that there was not much communication, much less any chemistry, between the two artists during the English sharing session, where both artists made speeches.

As the exhibition is in Hong Kong, Hahn of course could not speak about her work in her native language, German. Her English had a strong accent, but otherwise, she seemed able to communicate her ideas clearly to the audience. Kwan, on the other hand, was not fluent in English and decided to conduct his speech in Cantonese. Luckily for him, the entire audience understood Chinese — except for Hahn and Elliott.

This inability to communicate in the same language definitely explains, or at least contributes towards, the reason that the artists did not interact much during the short time they had known each other, as Hahn stated in interview. The German artist even went on to say that in essence, their works were separate.

“Chi’s a very poetic person,” she said. “We’re very different personality-wise. Because of this, we have our own approaches to making art. What David and Angelika hoped for us was that we would interact, understand and learn from each other’s ways. But we are not making a crossover here. The pieces stand as individual.”

There was obvious weight on Hahn’s works over Kwan’s — the German artist’s pieces outnumbered the latter’s three pieces by 26. But Kwan’s works, especially Hong Kongese, was the most impactful to the local resident. Observing the many types of visitors who wandered into the exhibition over a couple of days, the one piece of artwork that captivated all was the large-scale installation with which the visitor could interact.

As he described this work, he did not mention the other half of the exhibition altogether — this includes both the other artist and her pieces.

Inspired by the topical issue of identity, Kwan has covered the floor with tiny red and gold lapel badges depicting the flags of China saying “Hong Konger,” leading to a door that opens up to a bright white room. By scattering the badges all over the floor, his art goes straight to the heart of the question of what it means to be a Hong Konger today.

“I got these pins customised on Taobao,” he said. “I find it funny how you can buy your identity on the Internet.”

The only similarity between Hahn and Kwan’s works is that all of the pieces were inspired by Hong Kong. With just one link between the two series, can a typical person without any arts education even tell that they are supposedly a collaboration?

Elliot said that he did not think art has to be explained. Yet, without his explanation of the two artists’ works during the sharing session, it really was difficult for the audience to understand what brings Hahn and Kwan’s works together as one. They are different in creative medium, different in origin, and the artists have had minimal communication with each other. The average passer-by would not to able to depict the “woven” connections that the curator had dressed up so fancily in words.

Likewise, John Batten, president of the International Association of Art Critics Hong Kong, agreed that art does not need to be explained.

“Today, there are many press conference-type events like a dinner with the artists or gallery owners,” he said. “They feel like propagandas to feed a certain viewpoint to the public. The best thing for the public to do to appreciate art is to see an exhibition cold, form questions then try and work out the piece on their own — being spoon-fed an explanation takes away from the experience. Today, art is more than just the intentions of the creators. The audience can take away what they want from an exhibition and that becomes what that piece does, too.”

Another prominent player in the local art scene, Mark Spiegler, the director of annual art fair Art Basel, explained his definition of “good art.”

“Good art is something that changes you. Often, it’s a momentary attraction between a piece and a viewer,” he said. “How do you know it changes you? You walk away with a new aesthetic, a new experience, a different person. If a piece of work scares you, makes you uncomfortable and you’re thinking about it after, you’re affected.”

Art is like the relationship between prose and poetry. Prose is the direct conscience of information from writer to reader and poetry works on a subconscious level. If the viewer does not walk away from Social Fabric seeing the connection between Hahn’s and Kwan’s work, perhaps only understanding it when it is put into words for them, or is not walking away feeling affected in any way, then Elliott and Li have essentially failed in their exhibition. The two artists’ works are, to put it simply, just two collections forced together by prose in order for Mill6 Foundation to have something to show for its spring exhibition.

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Choi Sai-Ho, the Laptop Musician Syncing up Hong Kong

Choi Sai-ho plays electronic music in Hong Kong.

At around seven o’clock in the evening, one might cross paths with Choi Sai-ho among a crowd of office workers rushing to get home after a long day of work on the MTR. He is camouflaged against them—dressed in an ironed blue shirt, dark jeans and polished shoes, he checks his watch for the time and squints to read the face through his thick-rimmed glasses. He blends completely into the mass of skinny, thirty-year-old businessmen, but unlike everyone else, Choi isn’t in a hurry to get home for dinner. Instead, he is in a hurry to get to his latest gig in an underground dungeon.

“The first time I attended an electronic music concert was one by the Chemical Brothers who really ‘wow’ed me with their looks,” he says. “They were so cool. After the performance, I wondered if it was possible to make the type of music they played on my own—just using my own computer and software.”

The bag that Choi carries contained a laptop, yes, just like any typical office worker also on the MTR. But the laptop that has followed him throughout the years of his experimental venture wasn’t used for checking emails. Open it up and the average person wouldn’t be able to decipher the complicated music-making programs at all. Completely opposite from his appearance, he is someone else altogether: Choi Sai-ho is an electronic musician.

Born and bred in Hong Kong, Choi, who is 32 this year, followed the typical path of education and attended university after spending his childhood in local school. When he graduated with a master’s degree from City University’s School of Creative Media, he had no idea he would end up creating and playing music. In fact, he was heading in a different direction altogether. He was working to get a job in graphic design.

“I tried many things in university. Music was just one of them,” he says. “It wasn’t until later that I thought, hey, maybe I can make a career out of it. Maybe I can try it and see what happens.”

Although becoming an electronic musician in Hong Kong requires no formal qualifications or training, Choi didn’t go into the field completely inexperienced. Even though he had had no schooling in the subject apart from the compulsory primary school music lessons, he had played the violin outside of school during his childhood. Later on, he even formed a band with a group of friends.

“But that didn’t work out in the end,” he says. “The main problem with working in a group is that you need to have a common goal, you need to want to achieve the same things.” He continued that for a while. All of the members were at different places of their lives, but the experience, though brief, was enough to reignite his interest in the music world.

Growing up in a time before accessing the internet became an everyday thing for the common citizen, the only music Choi could listen to was what was played on mainstream radio. He only ever heard the same singers dominating the scene and perhaps it was because of this that he tired quickly of Cantonese music, known colloquially as ‘Cantopop’. He was constantly on the search for different types of sounds.

“I’m not saying that Cantopop isn’t good,” he straightens this out quickly. “I liked certain singers and songs. But I feel the quality has gotten worse with time. Teenagers used to listen to Cantopop in the 80s and 90s, but today’s generation doesn’t. They choose to look to other places for music, they like kpop, jpop and foreign singers.”

Aphex Twin, Squarepusher and Venetian Snares, the musicians who Choi counted off as his favourites, are names that are virtually unheard of in Hong Kong. The 32 year old laughed but shook his head in a downhearted manner as he described the identical blank expressions of every person he has ever mentioned his inspirations to. Hardly anyone ever recognises the names.

“Sometimes if I mention DJ Shadow, who’s more mainstream, I get a more satisfying reaction. But you can see how it is here. The industry for electronic music in Hong Kong is a disaster.”

Yet Choi, knowing full well the “disaster” of a market for the genre in Hong Kong, was adamant he wanted to pursue a path in electronic music because it was something different, something special, to his ears. It was nothing like what he had heard growing up. To the outsider, it certainly seemed like a bad decision to make in a city that only cares about money, but surprisingly, unlike the common ‘tiger mother’s of Hong Kong, his parents were happy to let him do what he wanted.

Having performed globally, Choi has definitely had a taste of the electronic music scene elsewhere in the world. In every overseas location he has played in, including Switzerland, Germany and Brazil, he has been met with a more enthusiastic reaction from the audience. But he shrugs as he defends Hong Kong when comparing the different situations, concluding simply that he understands the culture of his hometown. The people here are just not as expressive because of the way they had been brought up.

“People always joke to me that when I perform to a Hong Kong audience, it must be like performing to a pile of bricks,” he laughs lightheartedly. “They take electronic music in with an attitude that’s for listening to classical music. Someone has even said to me that when I’m performing, it looks like I’m checking my emails on stage!”

Although electronic music has a small audience base locally, Choi is still insistent on staying in the city where he grew up. He was also determined not to switch to a more mainstream style because he found that where he was at allowed the most honest expression of himself. Being an awkward talker, electronic music is his voice. Plus, he adds, he is beginning to see a ray of hope—an improvement in the popularity of lesser-known music genres in the recent years.

“There is definitely more variety in the music scene nowadays. The audience is transforming. You can even see small indie bands like Chochukmo doing large scale adverts even though they’re singing English songs and not Cantopop.”

There is a pause.

“And I’ve always wanted to do something in Hong Kong. It’s a challenge but it’s my home. If I can achieve something here, then that’s the happiest thing for me, much more than if I make it big in other countries.”

It might not be easy making a living from being a full time electronic musician, but Choi showed—and still shows—that it isn’t impossible. Over the years, he has grown from a young boy with no musical background to a man who holds at least several gigs a year, at places ranging from small underground venues to large music festivals, like Clockenflap. He has also collaborated with many famous artists of different genres and has been approached by the government for public talks and music workshops. In 2013, he received the Award of Young Artist in Media Arts from the Hong Kong Arts Development Council, which funded much of his second independently produced album, Sync.

So what’s in the future for the young star?

“I want to perform in Hong Kong’s biggest venues, like the Convention and Exhibition Centre. Oh, or even better, the AsiaWorld-Expo—but definitely not now!” He laughs as he imagines the situation. “Perhaps in the future. I don’t have a big audience now. It would be quite embarrassing!”

Image source: Choi Sai Ho 蔡世豪

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